Premature rupture of membranes (PROM) refers to membrane rupture before labor, a common delivery complication. Once membranes rupture, the uterine cavity becomes directly exposed to the external environment. External bacteria can ascend through the vagina, potentially causing intrauterine infection.
We generally classify preterm premature rupture of membranes into two scenarios. The first occurs before 37 weeks, often due to infection weakening the membranes and causing premature rupture. Since the baby is not yet full-term, measures to preserve the pregnancy are necessary. The second scenario involves rupture after 37 weeks, typically caused by malpositioning of the fetus or uneven pressure on the anterior amniotic sac. In these cases, timely induction of labor is required to terminate the pregnancy as soon as possible.
Some expectant mothers may worry that without the cushioning effect of amniotic fluid, external pressure could harm the fetus. However, amniotic fluid is continuously replenished through fetal urination, swallowing, and amniotic membrane secretion, so excessive concern is unnecessary.
Important Note:
Women with premature rupture of membranes must be hospitalized immediately and remain on bed rest. If the fetal head is high floating or the fetus is in breech or transverse presentation, the foot of the bed should be elevated to prevent cord prolapse. Close monitoring of amniotic fluid characteristics and fetal heart rate is essential to prevent fetal distress. Preventing infection is crucial after membrane rupture; antibiotics should be administered as appropriate if rupture exceeds 12 hours.Maintain perineal hygiene.
1. When preterm rupture occurs near term with a mature fetus, absence of malpresentation, pelvic stenosis, or cord prolapse, and a low presenting part, labor progression is often unaffected, allowing vaginal delivery.
2. If labor has not commenced within 12 hours of membrane rupture, and there are no complications such as malpresentation or cephalopelvic disproportion, induction may be performed with appropriate infection prophylaxis. However, if infection cannot be completely ruled out, or if malpresentation, fetal distress, or other complications are present, an emergency cesarean section should be performed immediately. Postoperative administration of broad-spectrum antibiotics is essential for infection prevention.
3. When membranes rupture far before the due date, the fetus is immature, and the mother urgently requests pregnancy preservation, the physician should administer pregnancy preservation therapy after ruling out infection and actively promote fetal lung maturation. Closely monitor the mother's temperature, pulse, uterine tenderness, amniotic fluid odor, and changes in fetal heart rate and movements. Administer antibiotics safe for the fetus, such as penicillin-based drugs.Maintain perineal hygiene and avoid unnecessary rectal or vaginal examinations. If fetal heart rate irregularities or potential infection are detected, terminate the pregnancy immediately regardless of gestational age. II. Turbid Amniotic Fluid Amniotic fluid is the lifeblood of the fetus. Transparent and colorless in early pregnancy, it turns milky white during late gestation.When the fetus experiences intrauterine hypoxia, it can cause hyperactive intestinal peristalsis, expelling meconium into the amniotic fluid and contaminating it. Therefore, the condition of the amniotic fluid directly reflects whether the fetus is experiencing hypoxia and whether it is safe in the uterine cavity. The more severe the fetal hypoxia, the darker the amniotic fluid color. In cases of mild hypoxia, the amniotic fluid is pale yellow, while in severe hypoxia, it becomes viscous and dark green.The above conditions are collectively termed meconium-stained amniotic fluid. Note: Oxygen deprivation can cause fetal distress. During labor, healthcare providers assess fetal well-being based on amniotic fluid characteristics. Fetal heart rate changes are monitored via fetal heart rate monitors, and delivery timing is determined according to amniotic fluid appearance and contamination levels.If cervical dilation is sufficient for imminent delivery, the doctor will stimulate contractions and may use vacuum extraction or forceps if necessary. In cases of severe amniotic fluid contamination and significant fetal hypoxia, the doctor will decisively perform a cesarean section to rapidly remove the fetus from the adverse environment.
III. Intrapartum and Postpartum Hemorrhage
Postpartum hemorrhage is defined as vaginal blood loss exceeding 400 milliliters within 24 hours after delivery.This is one of the major causes of maternal mortality, occurring in approximately 1% to 2% of deliveries. It typically happens within the first two hours postpartum. Rapid, massive blood loss weakens the mother's resistance, increasing susceptibility to puerperal infection. Prolonged shock can lead to pituitary ischemia and necrosis, potentially resulting in postpartum hemorrhage syndrome.Therefore, mothers must collaborate with healthcare providers to prevent postpartum hemorrhage. Primary causes include: 1. Excessive psychological stress 2. Retained placenta 3. Coagulation disorders Note:
Pregnant women must undergo thorough prenatal examinations. Those with a history of postpartum hemorrhage, bleeding disorders (e.g., hematological diseases, hepatitis), or multiple prior curettages should be admitted early for delivery. Blood typing should be completed, and blood reserves prepared to address any unforeseen complications during childbirth.Postpartum hemorrhage is often unpredictable and occurs suddenly, making prompt care critical: If uterine atony causes bleeding, immediately massage the uterus to stimulate contraction or apply pressure to the abdominal aorta to reduce blood loss.
IV. Dystocia
Dystocia refers to an abnormally slow progress of labor, increasing morbidity and mortality risks for both mother and fetus.Dystocia broadly describes situations during labor that cause problems for the baby itself, or result from maternal factors like narrow pelvic cavity, uterine or vaginal structural abnormalities, or weak or abnormal uterine contractions. Literally meaning "difficult birth," its clinical manifestation is slow or even arrested labor. Dystocia primarily arises from qi and blood deficiency or qi stagnation and blood stasis, which impair the normal activity of the uterus.Successful vaginal delivery depends on three key factors: labor force, birth canal, and the fetus. Abnormalities in one or more of these factors can lead to difficult labor. Note: Prolonged labor poses significant risks to both maternal and fetal health. Therefore, thorough prenatal examinations are essential. Identifying and promptly addressing abnormalities is a crucial preventive measure against difficult labor.The most effective approach is to attend regular prenatal checkups at a qualified hospital. Pelvic measurements should be taken during late pregnancy to enable comprehensive assessment of maternal and fetal conditions. Typically, around two weeks before the due date, the doctor will determine the delivery method and inform the expectant mother in advance. This allows her to understand whether natural delivery is possible, if trial of labor is recommended, or if a cesarean section is necessary, enabling both mental and material preparation.